The aim of this K24 application is to enable me to mentor young investigators so they may successfully integrate translational, clinical, outcomes and health services research methods to optimize management of patients with gastrointestinal and liver disease. I have developed a successful NIH-funded program of patient- oriented research and have an established record of mentoring junior investigators who have been successful in conducting patient-oriented research, publishing in peer-reviewed journals and obtaining NIH support of their own. I have been invited to teach patient-oriented research design to national and international audiences and have published several reviews of research techniques in leading journals. Mentoring plan: My environment at the University of Washington allows young investigators to obtain formal training in clinical study design, epidemiology and biostatistics. I propose to teach quantitative analysis in order to generate hypotheses, which can be tested through properly designed prospective clinical trials. Data derived from these studies can be integrated into revised decision models to identify the optimal competing strategies of management, which can then be prospectively tested via comparative effectiveness. I plan to improve my mentoring skills by participating in regional programs of mentor development and through formation of the Mentorship Committee for the University of Washington Department of Medicine. Research plan: Two main themes of my personal research portfolio are expressed in this application: increasing adherence to screening for colorectal neoplasia, and comparative effectiveness analysis of strategies to detect and manage Barrett's esophagus. This broad range of topics allows my mentees to be exposed not only to different study designs but also different scientific content. In this manner I am able to assist each junior investigator to develo a unique niche within the greater community of patient-oriented investigation. Regarding adherence to screening for colorectal neoplasia, my projects include: 1) 3-year follow up of a prospective randomized clinical trial comparing adherence to competing colorectal neoplasia screening strategies, 2) identification of health beliefs associated with screening adherence, 3) the impact of trust in physicians on screening adherence, 4) shared decision-making influence on adherence, and 5) development and validation of an interactive multimedia program to increase adherence to the colonic preparation required for colonoscopy among low- literacy underserved populations. My studies examining Barrett's esophagus include: 6) comparative effectiveness analysis of competing strategies to screen, survey and treat patients with Barrett's esophagus, 7) multiscale modeling incorporating molecular mechanisms of cancer development into population models to test how precision medicine may improve risk stratification and detection, prevention and treatment of Barrett's esophagus and esophageal cancer, and 8) prospectively utilize novel imaging techniques to identify en-vivo morphological changes associated with Barrett's esophagus and dysplasia, and incorporate epigenetic tools to further characterize molecular changes that enhance cancer risk stratification. These studies will form the basis for my training program for junior faculty, gastroenterology fellows, residents in training, post-doctoral fellows and medical and PhD students. My overall goals are to combine these research projects with formal training in patient-oriented research to provide the foundation necessary for my mentees to establish an independent research program and a successful career in academic medicine.